The Cost-effectiveness Analysis of Nurse-Family Partnership in the United States.

We evaluated whether Nurse-Family Partnership might serve as a cost-effective social policy for improving health. Using data from studies of randomized controlled trials as well as real-world data, we conducted a Monte Carlo simulation to estimate cost-effectiveness of Nurse-Family Partnership in a hypothetical cohort of first-born children in the United States. Analyses were conducted in 2015. Were all new mothers eligible for Nurse-Family Partnership, the program would produce 0.11 QALYs (95% confidence interval [CI]=0.06, 0.17) at an additional cost of $1,021 (95% CI=-$2,831, $4,414) per nurse-visited child's lifetime relative to the comparison-group children or $14,642 (95% CI = Savings, $71,877) per QALY gained. However, if applied to high-risk mothers, it would generate 0.19 QALYs (95% CI = 0.09, 0.44) and a net benefit of $2,764 (95% CI =-$1,210, $7,092) per nurse-visited child. Nurse-Family Partnership should be considered as a policy investment, particularly in an era of investments in the social determinants of health.

Potential Medicaid cost savings from maternity care based at a freestanding birth center.

OBJECTIVES: Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce costs to the Medicaid program. This study draws on information from a previous study of the outcomes of birth center care to determine whether such care reduces Medicaid costs for low income women. METHODS: The study uses results from a study of maternal and infant outcomes at the Family Health and Birth Center in Washington, D.C. Costs to Medicaid are derived from birth center data and from other national sources of the cost of obstetrical care. RESULTS: We estimate that birth center care could save an average of $1,163 per birth (2008 constant dollars), or $11.6 million per 10,000 births per year. CONCLUSIONS: Medicaid is the leading payer for maternity services. As Medicaid faces continuing cost increases and budget constraints, policy makers should consider a larger role for midwives and birth centers in maternity care for low-risk Medicaid pregnant women.

A practical approach for calculating reliable cost estimates from observational data: application to cost analyses in maternal and child health.

BACKGROUND: Comparative effectiveness research (CER) and cost-effectiveness analysis are valuable tools for informing health policy and clinical care decisions. Despite the increased availability of rich observational databases with economic measures, few researchers have the skills needed to conduct valid and reliable cost analyses for CER. OBJECTIVE: The objectives of this paper are to (i) describe a practical approach for calculating cost estimates from hospital charges in discharge data using publicly available hospital cost reports, and (ii) assess the impact of using different methods for cost estimation in maternal and child health (MCH) studies by conducting economic analyses on gestational diabetes (GDM) and pre-pregnancy overweight/obesity. METHODS: In Florida, we have constructed a clinically enhanced, longitudinal, encounter-level MCH database covering over 2.3 million infants (and their mothers) born alive from 1998 to 2009. Using this as a template, we describe a detailed methodology to use publicly available data to calculate hospital-wide and department-specific cost-to-charge ratios (CCRs), link them to the master database, and convert reported hospital charges to refined cost estimates. We then conduct an economic analysis as a case study on women by GDM and pre-pregnancy body mass index (BMI) status to compare the impact of using different methods on cost estimation. RESULTS: Over 60 % of inpatient charges for birth hospitalizations came from the nursery/labor/delivery units, which have very different cost-to-charge markups (CCR = 0.70) than the commonly substituted hospital average (CCR = 0.29). Using estimated mean, per-person maternal hospitalization costs for women with GDM as an example, unadjusted charges ($US14,696) grossly overestimated actual cost, compared with hospital-wide ($US3,498) and department-level ($US4,986) CCR adjustments. However, the refined cost estimation method, although more accurate, did not alter our conclusions that infant/maternal hospitalization costs were significantly higher for women with GDM than without, and for overweight/obese women than for those in a normal BMI range. CONCLUSIONS: Cost estimates, particularly among MCH-related services, vary considerably depending on the adjustment method. Our refined approach will be valuable to researchers interested in incorporating more valid estimates of cost into databases with linked hospital discharge files.

The role of the interpreter/doula in the maternity setting.

Health care organizations often struggle with issues related to communication with patients who have limited English proficiency. Providing quality interpreter services is necessary to comply with regulatory mandates and to provide safe, effective health care. Maternity care presents a unique situation due to the intimate and unpredictable nature of birth. A unique interpreter/doula program in which trained medical interpreters received additional education in labor and postpartum doula skills was tested at a large urban hospital maternity center with a large population of Spanish-speaking patients. Results showed that interpreter/doulas can offer timely, competent care in a variety of maternity situations. They also were cost-effective and associated with increased patient and staff satisfaction.

Turning simulation into reality: increasing student competence and confidence.

Clinical experiences are an essential part of nursing education as students learn technical skills, build on critical thinking skills, and hone skills in patient teaching. To build competence and confidence in each of these skill areas, an innovative clinical experience for senior students enrolled in women's health nursing was developed to provide nursing care and independent discharge teaching for postpartum mothers. Faculty facilitated this clinical experience by designing a simulation laboratory for students to practice their maternal self-care teaching and infant care skills prior to beginning their clinical rotation. In the hospital, students spent a day independently prioritizing new mothers' need for education and teaching new mothers to care for themselves and their newborns. Students reported confidence in teaching maternal self-care and newborn care, and satisfaction with this unique clinical experience. This approach may assist students in transferring skills learned in simulation laboratories to clinical practice.

Maternity care. Eyes on storks.

Critics of the DoH's new maternity policy document fear it will be as'pie in the sky' as its predecessor. Midwifery leaders say pay, frozen budgets and frozen posts have led to mass disillusion. One proposed solution for easing the pressure--maternity support workers--has raised safety fears.

Ejercicio liberal de la enfermera(o) en el área materno infantil / Liberal exercise of nursing in the infantile maternal area

Este artículo hace referencia a los resultados de la investigación sobre el ejercicio liberal de la enfermera(o) en el área materno-infantil, donde se refleja cuál es el desempeño de la enfermera en el ejercicio liberal de su profesión en el área materno-infantil en Santafé de Bogotá. Para realizar esta investigación se propusieron tres objetivos particulares: caracterizar el desempeño liberal de la enfermera en labores propias del área materno-infantil; identificar el papel que ha desempeñado la enfermera en el ejercicio liberal de la enfermería en el área materno-infantil; identificar las actividades que han realizado las enfermeras en el ejercicio liberal de la disciplina. La metodología utilizada corresponde a un diseño de tipo fenomenológico, descriptivo, analítico, cuya técnica central es el análisis de contenido. El universo del trabajo fueron las enfermeras que ejercen la enfermería en forma liberal en el área materno-infantil en Santafé de Bogotá. Los hallazgos se presentaron acompañados de gráficas alusivas al tema, y se obtuvieron interesantes conclusiones

State regulation, payment policies, and nurse-midwife services.

State regulatory and reimbursement policies continue to exert a strong influence on health workforce policy. Surveys conducted in 1991 and 1995 for the purpose of examining the impact of state regulation on the supply and practice of certified nurse-midwives (CNMs) showed that the single best predictor of the distribution and practice activities of CNMs was the degree to which state policies facilitated or restricted CNM practice.

A randomized trial of early discharge and nurse specialist transitional follow-up care of high-risk childbearing women.

In a randomized clinical trial, quality of health care as reflected in patient outcomes and cost of health care was compared between two groups of high-risk childbearing women: women diagnosed with diabetes or hypertension in pregnancy. The control group (N = 52) was discharged routinely from the hospital. The intervention group (N = 44) was discharged early using a model of clinical nurse specialist transitional follow-up care. During pregnancy, the intervention group had significantly fewer rehospitalizations than the control group. For infants of diabetic women enrolled in the study during their pregnancy, low birth weight (< or = 2,500 g) was three times more prevalent in the control group (29%) than in the intervention group (8.3%). The postpartum hospital charges for the intervention group were also significantly less than for the control group. The mean total hospital charges for the intervention group were 44% less than for the control group. The mean cost of the clinical specialist follow-up care was 2% of the total hospital charges for the control group. A net savings of $13,327 was realized for each mother-infant dyad discharged early from the hospital.

Two evaluations of combined mother-infant versus separate postnatal nursing care.

Combined mother-infant postnatal nursing care was compared with traditional, separate postpartum and newborn care in two studies. In Study I, self-administered questionnaires were completed by 408 mothers and 63 staff nurses. Data were collected both before and after mother-infant care was implemented. Benefits of the new system included increased maternal competence and satisfaction with parent education, parent-infant contact, and the nurse-client relationship, increased staff satisfaction, with no increase in operational cost. There were no breastfeeding differences, but ways to improve duration were implied by reasons for stopping. These findings were replicated in a separate setting with similar sample sizes. However, in the latter case, low staff ratios appeared to limit the benefits of mother-infant care to multiparas rather than primiparas.

Nursing protocols for antepartum home care.

Home care for women experiencing high-risk complications of pregnancy is a growing phenomenon. Home-care protocols for basic antenatal visits and the common conditions managed at home, such as preterm labor, premature rupture of membranes, bleeding, pregnancy-induced hypertension, chronic hypertension, and diabetes during pregnancy, are presented. Knowledge of protocols guiding home care of the antepartum client enhances communication, collaboration, and coordination and ultimately fosters dialogue, which can improve the quality of care for women.

Nurse-managed postpartum home care.

In 1989, Professional Nurse Associates, Inc., and Kaiser Permanente of Ohio collaborated to provide a home-centered postpartum recovery program to meet the postdelivery health-care needs of mothers, neonates, and families after a shortened hospital stay. This article reviews the history, process, and outcomes of that joint effort. The authors describe outcomes in terms of type and frequency of nursing diagnoses found on home visits, readmission rates, cost savings, and consumer satisfaction.

Strategies for change: nursing implementation of the birthing room.

Nurses were primary participants in introducing the birthing room for maternity care in their respective institutions. Based on tape-recorded interviews, this paper is a report on how the idea of a birthing room was initiated, the resistance it encountered, the eight strategies used to implement the idea, and appropriation of the idea by physicians. Although the examples are specific to the development of a birthing room, the strategies can be used by nurses to initiate other changes in perinatal health care delivery. In addition, increased collaboration between nurses and physicians may make some strategies obsolete.